Is Most Homelessness Tied to Drugs and Alcohol?

Statement: “Almost all homelessness is linked to drugs or alcohol,” El Cajon Mayor Bill Wells said in an Oct. 29 interview with Fox 5 San Diego.

Determination: False

Analysis: El Cajon has the region’s second-largest number of hepatitis A cases, and city leaders there have redoubled efforts to combat the health crisis recently.

One response was a controversial October City Council vote to temporarily ban feeding homeless people at parks and other city properties.

Mayor Bill Wells has described rampant addiction among El Cajon’s homeless population in the weeks since, arguing that rising drug use and street homelessness helped fuel the hepatitis A outbreak.

In an interview with Fox 5 San Diego, Wells claimed nearly all homelessness is tied to drug or alcohol abuse.

Wells’ perspective is a common one and shapes both local and national discussions about how cities should address homelessness, so I decided to fact check his claim. Statistics like those Wells’ cited can give residents and elected officials ammunition to blame homeless people for their predicaments and provide cover for not exploring solutions that may be costly or controversial.

I reviewed several studies and surveys, most of them national, and talked with national experts on homelessness to dig into Wells’ claim.

None of those sources confirmed that most homelessness is linked to drugs or alcohol, as Wells claimed.

The lion’s share of research and the experts I spoke with instead suggested somewhere between 25 percent and 40 percent of the nation’s homeless population is struggling with alcohol or drug addiction, or both.

Surveys of homeless San Diegans during the county’s most recent point-in-time count followed a similar trend.

During January’s homelessness census, 14 percent of those surveyed reported struggling with substance abuse, and another 10 percent with alcohol addiction.

Experts acknowledged this data isn’t precise. Much of the research is dated and surveys during the annual census rely on reports from homeless people themselves.

But each agreed that homelessness and addiction aren’t as directly linked as Wells suggested.

“It’s definitely very clear that drug and alcohol problems are more common among homeless people than people in general,” said Steve Berg, vice president of the Washington D.C.-based National Alliance to End Homelessness. “It’s a long way from being the whole problem.”

Berg also pointed to a 2006 Connecticut study where about 25 percent of homeless people surveyed named drug use as the prime cause of their homelessness.

Studies do show a higher incidence of alcoholism and substance abuse among single adults who are homeless, a group that makes up about two-thirds of the homeless population.

Dennis Culhane, a University of Pennsylvania professor renowned for his homelessness research, conducted in-depth research on the topic in the 1990s. He said he found about a “50 percent lifetime substance dependence rate” among single adults who were homeless.

Yet when you factor in homeless families, Culhane estimated the rate of substance abuse would fall to about 35 percent.

Culhane and Berg acknowledged there may be a spike in the percentage of the homeless population struggling with addiction amid the opioid crisis that’s battering cities across the United States.

Culhane said that crisis may have increased the rate of substance abuse addiction by 20 percent – or even more.

But Culhane said even a substantial increase in that rate wouldn’t equate to a direct tie between addiction and homelessness in the way the El Cajon mayor implied.

“One could argue that it is inadequate treatment supports or inaccessible housing that are bigger drivers, because having these conditions doesn’t result in homelessness in and of themselves,” Culhane wrote in an email.

Matthew Doherty, executive director of the U.S. Interagency Council on Homelessness, struck a similar tone.

“What’s important to remember is that most people who have mental health issues and most people who have substance use issues are successfully housed in our communities, so it’s not those issues in and of themselves that necessarily result in homelessness,” said Doherty.

The consensus was clear: Wells’ claim that nearly all homelessness is linked to alcohol or drug addiction is false.

Yet Wells, the El Cajon mayor, said he stands by his assertion. Wells is a registered nurse with a doctorate in psychology who for years worked in emergency rooms. He said that experience convinced him that the statistics are off.

“I think a lot of these figures are politically motivated,” Wells said.

He described situations where homeless patients lied about their use of alcohol or methamphetamines, or rejected offers of beds at local shelters because they were unwilling to stop using drugs or alcohol.

Doherty said struggles to aid homeless San Diegans grappling with addiction should encourage policymakers and nonprofits to ensure there are a variety of ways to help people facing both addiction and homelessness.

For example, San Diego and other cities have seen some success with programs that don’t mandate sobriety. Project 25, a program led by Father Joe’s Villages, housed about three dozen homeless people who were frequent users of emergency services. Many struggled with addiction.

“It’s not that there’s one perfect approach that’s absolutely right for everybody, but if we don’t have a range of opportunities then often times the people with the biggest challenges are the ones who have no access to help at all,” Doherty said.